DIAGNOSIS AND MANAGEMENT OF DIABETES INSIPIDUS DURING PREGNANCY

Objective: To provide an overview of diagnostic and treatment strategies in pregnant patients with diabetes insipidus (DI). Methods: We review the changes in osmoregulation during normal pregnancy, characterize the various types of DI that can occur during pregnancy, and discuss the recommended management. Results: The incidence of DI is 2 to 4 cases per 100,000 gestations. Central DI can precede pregnancy or manifest initially during gestation. With preexistent central DI, pregnancy usually aggravates the disorder, and the requirements for antidiuretic hormone (ADH) usually increase. Such an effect is less likely to be noted in ADH-independent nephrogenic forms of DI. Currently, the major type of DI associated with pregnancy is a transient syndrome that is resistant to arginine vasopressin (AVP) but responsive to desmopressin (dDAVP); such cases of DI are often associated with liver abnormalities or preeclampsia. This syndrome is explained by excess vaso-pressinase, a placental enzyme which degrades AVP ...